Genocide or Family Planning?

Indian Health Service Policy in the 1960s and 1970s

Lisa Emmerich, History (photo BA)

"In the early 1970s a young American Indian woman visited her physician and made an unusual and
troubling request. She wanted to know if her doctor could perform a uterus transplant. Her doctor asked why. The
young woman reported that during her teens after the birth of a child, her doctors on the reservation told her
that they'd `fixed it' so she could not have children for a while," said Professor Lisa Emmerich, History.

Emmerich explored this scandal in her talk, "Erasing the Race: Native Americans and Federal Family
Planning Policies in the 1960s and 1970s," the first in this year's Friends of History lecture series.

Emmerich's sample is not an isolated misunderstanding between a patient and her doctor. During the
1960s and the 1970s, thousands of Indian women across the country were sterilized by Indian Health Service
(IHS) medical personnel with little or no regard for the women's cultures, traditions, or desires.

The sterilization story surfaced in a 1974 Akwesasne
News article. Dr. Connie Uri wrote that women at
the Claremore, Oklahoma IHS facility were sterilized, apparently without informed consent, an action Uri defined
as "genocide of the Indian people." Emmerich said, "Outraged American Indians picketed the Oklahoma,
IHS hospitals, denouncing sterilization both as a means of
birth control and as a means of exercising political control
over tribal communities."

The sterilization scandal occurred in a historical context
of a long-term contentious relationship between Native
Americans striving to maintain tribal cultures and traditions
and a federal government determined to force assimilation
into middle-class American culture. Within tribal
communities, women played vitally important roles as wives,
mothers, workers, political activists, and religious
leadersroles attacked by goverment assmiliation policies,
explained Emmerich. By the mid-nineteenth century, Native
American women were seen as "helpless captives of their own
cultures" doomed to a life of drudgery and poverty that could only
be relieved through so-called "rescue initiatives," such as
Bureau of Indian Affairs (BIA) sponsored schools.

The Save the Babies Campaign between 1912 and
1918 removed children from their homes and families. The BIA criticized Native American women for
maintaining their traditional ways of life, labeling them as incompetent for not adopting what was called "scientific
motherhood." While conditions of poverty and disease on the reservations, not parenting styles, threatened
children's health, it was "easier to demonize native women, their communities, and their traditions than to cooperate
with them to devise a solution," explained Emmerich. This ready classification of Indian women as inadequate
parents, and Indian families as dangerous environments for child rearing led directly to the meteoric rise in
the number of Indian child adoptions in the latter years of the twentieth century. Between a quarter and a third of
all American Indian children had been placed in institutions, foster families, or adopted out.

It is against this background that the sterilization allegations came to national and congressional attention
in 1976. Senator James Abourzek asked the General Accounting Office (GAO) to investigate. The
investigators visited four Native American communities. According to the GAO report, the four service areas were
"generally not in compliance with IHS regulations." They listed many violations such as inadequate consent forms,
medical personnel ignoring a wide range of requirements, and the sterilization of minors.

The GAO study found no evidence that Native Americans were forced
into sterilization. "However, GAO investigators acknowledged that many
tribal women believed they would lose BIA benefits, access to services, or custody
over their other children if they refused to do the procedure," said Emmerlich.
IHS personnel did not correct this perception.

According to the GAO report, 3406 Native American women between
the ages of fifteen and forty-four were sterilized between 1973 and 1976.
Because the investigators did not find any "systematic attempt to single out any
one American Indian nation and sterilize its child-bearing women," said
Emmerich, they concluded that this was not genocide. In Washington, congressmen
called for more investigation. On reservations, Native American activists
conducted their own surveys of women, finding more incidents of sterilization
without informed consent. As a direct result of the public reaction, new rules were
mandated for federally funded sterilizations, including providing interpreters
for non-English speakers, allowing witnesses to accompany a patient during
her discussion with a doctor, forbidding sterilization of minors, assuring
patients that their benefits will not be denied based on their medical decision, and
requiring a thirty-day waiting period.

While the BIA and IHS treat this episode as a "tragic anomaly," Emmerich suggested that the
episode stemmed from "centuries old misperceptions of American Indian peoples and their cultures. Indians were
`others,' outsiders set apart from the rest of American society by virtue of cultural, religious, economic, and
political differences. Within the bureaucratic medium of the IHS, slippery medical ethics, as well as class, gender,
and cultural prejudices met and fed on each other."